Provider Demographics
NPI:1750312997
Name:WELLSTAR NORTH FULTON HOSPITAL, INC
Entity Type:Organization
Organization Name:WELLSTAR NORTH FULTON HOSPITAL, INC
Other - Org Name:WELLSTAR NORTH FULTON HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP & CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUDZINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-644-0012
Mailing Address - Street 1:1800 PARKWAY PL SE STE 500
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8237
Mailing Address - Country:US
Mailing Address - Phone:470-956-4981
Mailing Address - Fax:770-999-2489
Practice Address - Street 1:3000 HOSPITAL BLVD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4915
Practice Address - Country:US
Practice Address - Phone:770-751-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060-357282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00275976AMedicaid
199132600OtherUS DEPT OF LABOR WORKERS
FL902706800Medicaid
OH2535591Medicaid
SC11053AMedicaid
MS19913260Medicaid
ALNOR0198NMedicaid
100012OtherBCBS OF GEORGIA
NC1100198Medicaid
SC11486BMedicaid
587768460OtherAETNA US HEALTHCARE (NATI
110198B000000OtherSECTION 1011
NJ46922Medicaid
100019OtherBCBS OF GEORGIA
LA1708127Medicaid
61882OtherAETNA US HEALTHCARE
9852OtherCOVENTRY HEALTH CARE LOUI
OH2535591Medicaid